Request LWVWA Sponsorship & Liability Coverage for a Local League Event

Request for LWVWA Sponsorship & Liability Insurance Coverage for a Local League Event

If liability insurance coverage is required by the owner of a facility where the local League wishes to hold a forum or event, you may request that the League of Women Voters of Washington’s (LWVWA) co-sponsor the event and provide liability insurance for $1 million. To request LWVWA sponsorship, please complete and submit this online form.

Local Leagues are asked to seek a local co-sponsor with the necessary insurance prior to applying for LWVWA co-sponsorship. Co-sponsoring an event with a local organization is a great way to build community alliances.

Once LWVWA staff receives the request from the local League, the LWVWA insurance underwriter will be contacted to obtain the certificate of insurance. Please allow at least 5 business days.

TIP: To make sure you gather all the information required below, print a copy of this form to refer to you when working with the people requesting a certificate of liability.

League Contact Name*

First NameLast Name

League Name*

E-mail*

Phone Number*

Area CodePhone Number

Has Your League Pursued Co-Sponsorship with other Organizations?

Yes, but co-sponsor doesn't have insuranceOther

Name of Event*

Event Date*

MonthDayYear

Start Time, including setup*

:HourMinutesAM/PM Option

End Time, including clean up*

:HourMinutesAM/PM Option

How many attendees do you anticipate?*

Venue Info*

Venue Name

Street Address

CityState / Province

Postal / Zip Code

Name of Entity Requesting Proof of Insurance exactly as it should be displayed on Certificate*

Entity's Address to print on the Certificate

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Entity Contact E-mail

Event Description*

What activities will your local League do at this event?*

Describe Insurance Requirements*

Does the requesting entity need to be named as an "Additional Insured" on our General Liability Policy? (This is additional documentation that venues sometimes request.)

yesno

Do you and the requesting entity have a signed contract? (Select "Yes" if you and the requesting entity are currently in the process of completing a written contract.)

yesno

Select any specific wording the certificate holder requires. If they don't require specific wording, click "I don't require any wording."*

Additional InsuredWaiver of SubrogationNotice of CancellationPrimary and Non-ContributoryATIMA (as Their Interests May Appear) and/or ISAOA (Its Successors and/or Assigns)Job Description / Contract NumberCustom Wording (Only for Special Circumstances). Note: Don't select custom wording unless the certificate holder asks for special language. You should choose one of the other options for most circumstances. You'll add the certificate holder's name on the next page.I don't require any wording

Required Custom Wording:

Date Proof of Insurance is Needed By*

MonthDayYear

Alcohol Statement*

I certify that alcohol will not be served at this event.

Will Food Be Served?

YesNo

Other Helpful Information

________________________________________

For The Office Use Only

STATUS

Date Co-Sponsorship Approved by LWVWA President

Date Applied to Insur. Co. for Certificate of Liability

Replied to Local League